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Anemia of Chronic Disease (Risk Factors (Type 2 Diabetes: the risk is…
Anemia of Chronic Disease
Pathophysiologic factor for Anemia of Chronic Disease: Inflammation
Usually for diagnosis of this condition the presence of a chronic inflammatory condition such as infection, autoimmune disease, kidney disease or cancer is required.
Cytokines such as TNF-Alpha, IL-1-Beta, interferon-beta continue to contribute to the decrease in EPO production by increasing hepcidin production. The hepcidin increase decreases the available iron due to it being "trapped" by macrophages in the liver that were present because of the inflammation.
Risk Factors
Type 2 Diabetes: the risk is doubled for ACD in patients in with DMII.
Chronic infection-Tuberculosis, Irritable bowel syndrome (IBS)
Autoimmune disease Especially Rheumatoid Arthritis (RA)
Cancer-Any cancer will cause effects on the hematological system-WBC and RBC effects are seen
Trauma-Acute loss of blood. Can also occur in episodes of menorrhagia
Post Surgery-loss of blood during surgery or from complications post surgery (ongoing bleeding)
Age-anemia increases with age due to loss of iron stores, lack of vitamins and concomitant illness such as infection, surgery, cancers, chronic kidney disease
Iron, folate, vitamin B12 deficiency
Causative Factor 1: Shortened RBC survival that is thought to be due to release of inflammatory cytokines. This likely occurs in patients with cancer or granulomatous infections. (i.e. TB, leprosy, valley fever, etc.)
Diagnostic Tests
blood tests include: Serum iron, transferrin, reticulocyte count, serum Ferris.
Iron Deficiency (ID) is the most common cause of anemia (IDA). New hematological markers are being studied to detect prescence of it earlier. Hypo-HE and hyper-He are % of blood cells with cellular hemoglobin content lower than 17pg and higher than 49pg. Micro R and Macro R are the % of microcytic and macrocytic RBC. There are statistically significant results that using the Hypo-HE and Micro R tests are useful in detection of ID in patients with
Common Findings
Hemoglobin level <13.0g/dl in men and <12g/dl in women
initially the RBC's are normocytic and with progression of the disease they become microcytic
Is often overlooked in clinical practice
Treatments
Epogen-Care must be taken for patient's with hypertension as this causes elevated BP which could induce stroke and or cardiovascular events such as MI.
Correct the underlying illness causing the anemia
oral iron supplements
Consume foods rich in iron such as red meats, organ meats, raisins,
Iron infusions
Blood transfusions are not frequent in patients with anemia of chronic disease as the anemia is usually more mild than some other forms of anemia
interventions to stop chronic blood loss such as endoscopy procedures to correct bleeding ulcers, endometrial ablation or hysterectomy to correct menorrhagia.
Pathophysiologic mechanisms (Causative Factors): Three pathophysiologic mechanisms have been identified
old blood cells' iron is retained by the Reticuloendothelial cells so that iron is unavailable for hemoglobin synthesis, and therefore a lack of the body's ability to make more RBC's.
Causative Factor 3: Iron metabolism alteration due to the increase in Hepcidin (Iron regulatory. hormone) which inhibits iron absorption and recycling and leads to iron sequesteration
Causative Factor 2: Erythropoieses, or blood cell creation is reduced due to the decrease of Erythropoieten (EPO) production and decreased responsiveness of the bone marrow to the EPO.
